title: Discordance between physicians' estimation of patient cardiovascular risk and use of evidence-based medical therapy.
abstract: Despite clinical trial evidence supporting the use of antiplatelets, angiotensin-converting enzyme inhibitors, and statins for cardiovascular risk reduction in high-risk patients, use of such therapies in real-world outpatients in the prospective Vascular Protection Registry and the Guidelines Oriented Approach to Lipid Lowering Registry was suboptimal (78%, 55%, and 75%, respectively). The most frequent reason physicians cited for nonprescription of statins (33%) was that patients were not high risk enough and/or current guidelines did not support statin use. In conclusion, outpatients at high cardiovascular risk continue to be undertreated as a result of a combination of physician underestimation of cardiovascular risk (knowledge gap) and barriers to implementation of evidence-based therapy (practice gap).
authors.affiliation: Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennifer L Y
authors.initials: JL
authors.lastname: Tsang
authors.forename: Aurora
authors.initials: A
authors.lastname: Mendelsohn
authors.forename: Mary K K
authors.initials: MK
authors.lastname: Tan
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Hackam
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.forename: David
authors.initials: D
authors.lastname: Fitchett
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lin
authors.forename: Etienne
authors.initials: E
authors.lastname: Grima
authors.forename: Anatoly
authors.initials: A
authors.lastname: Langer
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D002983:Clinical Competence; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011364:Professional Practice; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors